Impact of radiation source activity on short- and long-term outcomes of cervical carcinoma patients treated with high-dose-rate brachytherapy: A retrospective cohort study
Impact of radiation source activity on short- and long-term outcomes of cervical carcinoma patients treated with high-dose-rate brachytherapy: A retrospective cohort study
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放射源活动对接受高剂量近距离放射治疗的宫颈癌患者的短期和长期结果的影响：一项回顾性队列研究
DOI：
10.1016/j.ygyno.2020.08.037
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发表时间：
2020-11-01
影响因子：
4.7
通讯作者：
Zhang, Yibao
中科院分区：
文献类型：
--
作者：
Li, Chenguang;Li, Xiaofan;Zhang, Yibao
**目的**：使用铱 - 192源的高剂量率（HDR）后装近距离放射治疗，由于其快速衰变，会涉及较大的放射活度变化。评估这种变化对患者治疗结果的影响，以支持更明智的决策，这一点尚不明确，但在临床上很有必要。
**方法**：回顾性纳入510例宫颈癌（CC）患者的数据。根据每位患者所有分次治疗的特定平均剂量率（MDR），从统计学上定义高放射性（HR）组和低放射性（LR）组。使用R - 3.6.1软件包，依据与二元结局或生存时间的相关性显著性来计算临界值。将1个月和3个月的随访结果分类分析作为短期结局。使用局部无复发生存期（LRFS）和远处无转移复发生存期（MRFS）评估长期结局。生成倾向得分匹配（PSM）对以减少偏倚。
**结果**：中位随访时间为47.1个月（四分位间距：33.9个月 - 66.4个月），由于在93天至199天的间隔内进行了17次放射源更换，MDR变化高达9倍，范围从6059.99 cGy/h到54013.66 cGy/h。短期（1个月：p = 0.22；3个月：p = 0.79）和长期（LRFS：p = 0.10；MRFS：p = 0.46）结局显示，HR组和LR组之间均无显著差异。亚组分析显示，LR组中I - II期（3个月，p = 0.02）和II期（LRFS，p = 0.04）患者的治疗结果显著更好。LR组的LRFS和MRFS均显著不劣于HR组（p = 0.02）。
**结论**：对于使用HDR治疗宫颈癌，LR在临床上不劣于或部分优于HR，这消除了因放射源更换延迟可能损害患者治疗结果的担忧。（C）2020爱思唯尔公司版权所有。
Objective. High-dose-rate (HDR) afterloading brachytherapy using Iridium-192 source involves large radiation activity varieties due to fast decay. Itwas unknown but clinically desirable to evaluate its impacts on patient outcomes to support more informed decisions.Methods. Data of 510 cervical carcinoma (CC) patients were retrospectively included. High-radioactive (HR) and low-radioactive (LR) groups were statistically defined per patient-specific average mean-dose-rate (MDR) of all fractions. The cutoffs were calculated using R-3.6.1 packages based on significance of correlation with binary outcome or survival time. Categorized 1-month and 3-month follow-up results were analyzed as short-term out-comes. Long-term outcomes were evaluated using local recurrence-free survival (LRFS) and metastatic recurrence-free survival (MRFS). Propensity-score-matched (PSM) pairs were generated to reduce bias.Results. The median follow-up time was 47.1 months (interquartile range: 33.9 months-66.4 months), involving MDR varieties of up to 9 folds ranging from 6059.99 cGy/h to 54013.66 cGy/h due to 17 source replacements at intervals ranging from 93 days-199 days. Both short-term(1-month: p= 0.22; 3-month: p= 0.79) and long-term(LRFS: p= 0.10; MRFS: p= 0.46) outcomes showed no significant difference between HR and LR. Sub-group analysis displayed significantly better results in LR for stage I-II (3-month, p = 0.02) and stage II (LRFS, p = 0.04) patients. Both LRFS and MRFS of LR were significantly non-inferior to HR (p = 0.02).Conclusions. LR is clinically non-inferior or partially superior to HR for CC treatment using HDR, which dispels concerns of potentially undermined patient outcomes when source replacement is delayed. (C) 2020 Elsevier Inc. All rights reserved.